We forecast the company to gain share in the USD 5 billion sleep apnea treatment market as reimbursement becomes increasingly linked to evidence of patient compliance. We expect to see both commercial and national health insurance payers get on the connected device bandwagon, which benefits the duopoly of ResMed and Philips greatly.ResMed’s recent acquisitions of software services platforms for home healthcare practitioners is a new strategic direction and the company has already pieced together approximately 20% share in this USD 1.5 billion market.
Key Investment Considerations
- ResMed has a strong position in the structurally growing sleep apnea market, where volume growth has been more than sufficient to offset the price deflation headwind.
- Cash flow is robust with 100% of earnings represented by free cash flow over the preceding five years, a trend we forecast to continue.
- Risks remain around tax issues as ResMed has been subject to large tax charges in both the U.S. and Australia in the last two years. We are concerned about the reflection on corporate culture and the potential USD 300 million-plus in taxes and penalties payable.
- ResMed is taking a “smart devices” and “big data” approach to further entrench itself as one of the two leading players in the global sleep apnea market. The strategy is two-fold – accelerating diagnosis of the underpenetrated market and monitoring patient compliance which keeps diagnosed patients in the treatment net and payers happier to reimburse the cost of respiratory devices.
- The global sleep apnea market is only 20%-30% penetrated and respiratory device companies are making headway growing volumes around 10% per year, offset by average price deflation of 2%-3%. It is dominated by ResMed and Philips, which together make up an estimated 80% of the USD 5 billion value. ResMed plays a key role in driving diagnosis with its at-home sleep testing devices and ongoing education drive to create awareness of the disease.
- ResMed has demonstrated a robust top line despite experiencing pricing pressure, and this together with the low financial leverage, leads us to use a below-average cost of equity of 7.5%. This results in a company weighted average cost of capital estimate of 7.4%.
- The ResMed initiatives to improve sleep apnea diagnosis could result in an acceleration of revenue growth over the next five years. With the sleep apnea market an estimated 50% diagnosed in the U.S. and less in other major markets, the runway for growth is long.
- Pricing risk for durable medical supplies has played out and pressure could ease going forward resulting in faster top-line growth and expanding margins.
- The strategic focus on data to support product purchases positions ResMed well to demonstrate the value of its products to the healthcare system.
- The tax issues that came to light in 2018 could suggest a corporate culture that allows questionable practices in other areas like selling, which is regulated in the U.S.
- Future cash flows need to fund the total potential historical tax liabilities of USD 300 million over the upcoming years.
- ResMed is unproven as a software provider, an area it is currently directing a lot of capital to.
(Source: Morningstar)
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